建设胸痛中心对天水地区急性ST段抬高型心肌梗死救治的影响

Effect of building chest pain center on treatment of acute ST segment elevation myocardial infarction in Tianshui region

目的探讨建设胸痛中心对天水地区急性ST段抬高型心肌梗死(STEMI)救治的影响。方法比较2016年1月至2017年12月于甘肃省天水市第一人民医院胸痛中心建立前后收治的发病24 h内的474例STEMI患者,其中直接经皮冠状动脉介入治疗(PPCI)患者289例,将2016年1月至2016年12月(胸痛中心建设前)收治的患者作为非胸痛中心组,2017年1月至2017年12月(胸痛中心建设后)收治的患者作为胸痛中心组,比较两组患者的PPCI比例、溶栓比例、非PCI医院转诊比例、院内死亡比例、住院天数、住院费用,以及PPCI发病至首次医疗接触时间(S-FMC)、首份心电图时间、门球时间(D-to-B)、总缺血时间、绕行急诊和CCU比例的不同。结果相对于非胸痛中心组,胸痛中心组PPCI比例[76(45.8%)vs.213(69.2%),P<0.001]、非PCI医院转诊比例[53(31.9%)vs.172(55.8%),P<0.001]高于非胸痛中心组,住院天数[11(13,8)vs.9(12,7),P=0.001]、院内死亡比例[16(9.6%)vs.15(4.9%),P=0.045]低于非胸痛中心组;非胸痛中心组的溶栓比例高于胸痛中心组[33(19.9%vs.36(11.7%),P=0.016],两组住院费用[34166.83(42576.56,10679.16)vs.32503.35(39048.41,19410.39),P=0.837]差异无统计学意义。PPCI患者胸痛中心组首份心电图时间[15(18.75,10)vs.6.10(6.79,4.92),P<0.001]、D-to-B时间[90(105,80)vs.80(102,53.50),P<0.001]低于非胸痛中心组,绕行急诊和CCU比例[6(7.9%)vs.64(30.2%),P<0.001]高于非胸痛中心组,S-FMC时间[140(235,67.50)vs.120(2595.5,66.25),P=0.711]及总缺血时间[352.50(488.25,269.25)vs.350.50(514.25,244.25),P=0.714]差异无统计学意义。结论胸痛中心建设能优化STEMI的救治流程,降低院内病死率,但要不断的缩短S-FMC和总缺血时间还需加强公众胸痛知识的教育、持续的改进院前急救和院内绿色通道的建设。

Objective To explore the effect of constructing chest pain center on the rescue and treatment of acute ST elevation myocardial infarction(STEMI)in the Tianhui region.Methods A total of 474 STEMI patients within 24 hours of onset who were admitted to the chest pain center of the first people's Hospital of Gansu Province before and after establishment were compared between January 2016 and December 2017.Among these,289 patients who underwent direct percutaneous coronary intervention(PPCI)between January 2016 and December 2016(before construction of the chest pain center)were included as the non-chest pain center group,Patients admitted from January 2017 to December 2017(after construction of the chest pain center)were used as the chest pain center group to compare the PPCI proportion,thrombolysis proportion,proportion of non PCI hospital referrals,proportion of in-hospital deaths,hospital days,hospital costs,and PPCI onset to first medical contact(s-fmc),time to first ECG,door to balloon time(d-to-b),total ischemic time,differed in proportions of emergency department bypass and coronary care unit(CCU).Results The proportion of PPCI[76(45.8%)vs.213(69.2%),P<0.001],the proportion of non PCI hospital referrals[53(31.9%)vs.172(55.8%),P<0.001]and the proportion of days hospitalized[11(13,8)vs.9(12,7),P=0.001]and the proportion of in-hospital deaths[16(9.6%)vs.15(4.9%),P=0.045]were lower than those from non-chest pain centers,the proportion of thrombolysis in non-chest pain centers was higher than that in chest pain centers[33(19.9%)vs.36(11.7%),P=0.016],and the hospital costs[34166.83(42576.56,10679.16)vs.32503.35(39048.41,19410.39),P=0.837]were not significantly different between the two groups.Patients with PPCI in the chest pain center group had a higher time to first ECG[15(18.75,10)vs.6.10(6.79,4.92),P<0.001],d-to-b time[90(105,80)vs.80(102,53.50),P<0.001]than the non-chest pain center group,bypass emergency and CCU proportion [6 (7.9%) vs. 64 (30.2%), P<0.001] than the non-chest pain center group, s-fmc time [140(235, 67.50) vs.120 (2595.5, 66.25), P=0.711] and total ischemic time [352.50 (488.25, 269.25) vs. 350.50 (514.25,244.25), P=0.714] were not significantly different. Conclusion Chest pain center construction can optimize the flowof care for STEMI and reduce in-hospital mortality, but continuous reductions in s-fmc and total ischemic time willrequire enhanced public education in chest pain knowledge, continued improvements in prehospital first aid, andthe construction of green channels in-hospital.